Homophobia, poverty, poor ARV adherence, and apathy. Four easy pieces.
Reports are coming out of Uganda that PEPFAR funds are being used to promote the homophobic agenda of the government and NGOs in that country. A choice quote from Aidsmap:
James Kigozi of the Ugandan AIDS commission has defended the lack of any reference to gay or bisexual men in the country’s HIV strategy saying, “the practice of homosexuality is illegal.”
PEPFAR has become a slush fund for charlatans (abstinence only promotors, Halperin et al's circumcision) and repressive governments. As usual, money has corrupted so many who have received it in the name of a noble cause.
Most people will readily see the logical linkage between financial worries and health. In the US, it's a matter of ever-pressing concern. Two studies, one in the US and one a meta-analysis of Africa-based studies, have shown that if you are poor, you are likely to fail to adhere to your regimen. HIV may kill, but not without poverty. Secondary lesson: You can give people drugs, but you can't make them take them.
Finally, US researchers have announced the unexpected result that patients are presenting later for HIV treatment than nearly two decades ago. To cut through the clutter, the reasons are boiled down to insurance, universal testing, and the linkage between the two. Again, poverty is the culprit aided by poverty's help-mate, apathy. Poor people and the uninsured, groups that are often interchangeable, present later. And these groups exist in greater number in the US than in the last two decades. The article concludes:
Goicoechea and Smith agree with the study's authors that “these data support the argument for mainstream HIV testing,” but add that, “they also highlight the issue of universal health care coverage.”
“HIV disease is a disease of poverty," they note. "In the United States, HIV infection disproportionately affects uninsured, low-income persons, who constitute a vulnerable population that often has multiple health care needs.”
They conclude by arguing that, "‘universal’ HIV testing also requires ‘universal’ health care for there to be a significant impact on diagnosing HIV infection at the earliest stage possible. As the United States and other resource-wealthy countries move forward to build health care infrastructure and scale-up antiretroviral therapy in resource-limited settings, it is a shameful commentary on our own health care system that the average CD4+ T-cell count before the initiation of antiretroviral therapy in North America is similar to that of some underdeveloped countries in Africa.”
